Citation Nr: 0019836
Decision Date: 07/28/00 Archive Date: 08/02/00
DOCKET NO. 99-04 580 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in St. Louis,
Missouri
THE ISSUES
1. Entitlement to service connection for post traumatic
stress disorder (PTSD).
2. Entitlement to service connection for a left knee
disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
C. Trueba-Sessing, Associate Counsel
INTRODUCTION
The veteran had active service from September 1951 to March
1955 and from April 1956 to September 1969.
The case comes before the Board of Veterans' Appeals (Board)
on appeal from a December 1998 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
St. Louis, Missouri.
The Board notes that, on a February 1999 VA Form 9 (Appeal to
Board of Veterans' Appeals), the veteran requested a hearing
before a hearing officer at the RO. A hearing was scheduled
for April 30, 1999. However, the veteran's representative
canceled the scheduled hearing. The Board, therefore, deems
the veteran's February 1999 request for a hearing to have
been withdrawn.
FINDINGS OF FACT
1. The veteran has not received a diagnosis of PTSD.
2. There is no competent medical evidence that the veteran
currently has a left knee disability.
CONCLUSIONS OF LAW
1. The veteran's claim for service connection for PTSD is
not well grounded. 38 U.S.C.A. § 5107(a) (West 1991);
38 C.F.R. § 3.304(f) (1999).
2. The veteran's claim for service connection for a left
knee disorder is not well grounded. 38 U.S.C.A. § 5107(a)
(West 1991).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Service Connection.
Service connection may be granted for disability resulting
from injury or disease incurred in or aggravated by service.
38 USCA § 1110 (West 1991).
However, the initial inquiry in reviewing any claim before
the Board is whether the veteran has presented evidence of a
well-grounded claim, that is, one which is plausible or
capable of substantiation. The veteran carries the burden of
submitting evidence "sufficient to justify a belief by a
fair and impartial individual that the claim is well-
grounded." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1
Vet. App. 78, 81 (1990). If he has not presented a well-
grounded claim, his appeal must fail. While the claim need
not be conclusive, it must be accompanied by supporting
evidence; a mere allegation is not sufficient. Tirpak v.
Derwinski, 2 Vet. App. 609, 611 (1992).
A well-grounded claim for service connection requires that
three elements be satisfied. First, there must be competent
evidence of a current disability, as established by a medical
diagnosis; second, there must be competent evidence of an
incurrence or aggravation of a disease or injury in service,
as established by lay or medical evidence, as appropriate;
third, there must be competent evidence of a nexus or
relationship between the in-service injury or disease and the
current disorder, as established by medical evidence or a
medical opinion. See generally Epps v. Gober, 126 F.3d 1464
(Fed. Cir. 1997).
A service connection claim may also be well grounded, under
38 C.F.R. § 3.303(b), if evidence, regardless of its date,
shows that a veteran had a chronic condition in service and
still has such condition. Such evidence must be medical,
unless it relates to a condition as to which, under the
Court's case law, lay observation is competent. If a chronic
condition in service and since service is not shown, the
claim may still be well grounded on the basis of 38 C.F.R.
§ 3.303(b) if the condition is observed during service,
continuity of symptomatology is demonstrated thereafter, and
competent evidence relates a present disorder to that
symptomatology. Savage v. Gober, 10 Vet. App. 488,
493(1997).
II. PTSD.
Service connection for PTSD requires medical evidence
diagnosing the condition in accordance with 38 C.F.R.
§ 4.125(a); a link, established by medical evidence, between
current symptoms and an inservice stressor; and credible
supporting evidence that the claimed inservice stressor
occurred. If the evidence establishes that the veteran
engaged in combat with the enemy and the claimed stressor is
related to that combat, in the absence of clear and
convincing evidence to the contrary, and provided that the
claimed stressor is consistent with the circumstances,
conditions, or hardships of the veteran's service, the
veteran's lay testimony alone may establish the occurrence of
the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1999).
38 C.F.R. § 4.125 (1999) provides that a diagnosis of a
mental disorder shall conform to the Diagnostic and
Statistical Manual of Mental Disorders, 4th edition, of the
American Psychiatric Association (DSM-IV).
The DSM-IV diagnostic criteria for PTSD are:
A. The person has been exposed to a
traumatic event in which both of the
following were present: (1) The person
experienced, witnessed, or was confronted
with an event or events that involved
actual or threatened death or serious
injury, or a threat to the physical
integrity of self or others and (2) the
person's response involved intense fear,
helplessness, or horror.
B. The traumatic event is persistently
re-experienced in one or more of the
following ways: (1) Recurrent and
intrusive distressing recollections of
the event, including images, thoughts, or
perceptions. (2) Recurrent distressing
dreams of the event. (3) Acting or
feeling as if the traumatic event were
recurring (includes a sense of reliving
the experience, illusions,
hallucinations, and dissociative
flashback episodes, including those that
occur on awakening or when intoxicated).
(4) Intense psychological distress at
exposure to internal or external cues
that symbolize or resemble an aspect of
the traumatic event. (5) Physiological
reactivity on exposure to internal or
external cues that symbolize or resemble
an aspect of the traumatic event.
C. Persistent avoidance of stimuli
associated with the trauma and numbing of
general responsiveness (not present
before the trauma), as indicated by three
or more of the following: (1) Efforts to
avoid thoughts, feelings, or
conversations associated with the trauma
(2) efforts to avoid activities, places,
or people that arouse recollections of
the trauma (3) inability to recall an
important aspect of the trauma (4)
markedly diminished interest or
participation in significant activities
(5) feeling of detachment or estrangement
from others (6) restricted range of
affect (for example, unable to have
loving feelings) (7) sense of a
foreshortened future (for example, does
not expect to have a career, marriage,
children, or a normal life span).
D. Persistent symptoms of increased
arousal (not present before the trauma),
as indicated by two or more of the
following: (1) Difficulty falling or
staying asleep (2) irritability or
outbursts of anger (3) difficulty
concentrating (4) hypervigilance (5)
exaggerated startle response.
E. Duration of the disturbance (symptoms
and criteria B, C, and D) is more than
one month.
F. The disturbance causes clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning.
In the veteran's case, records of a VA mental health clinic
from April 1997 to May 1999 contain progress notes showing
that he "participated in the group process" of a PTSD
support group, whose members discussed many topics, ranging
from current events, music, and other matters of interest, to
military experiences. The group was conducted by a clinical
social worker. No specific statements made by the veteran in
the group were reported. The social worker's notes do not
contain a finding that the veteran met the DSM-IV criteria
for a diagnosis of PTSD and, if fact, do not contain any
diagnosis of the veteran's condition.
The veteran was seen in March 1999 by a VA mental health
clinic psychiatrist, who rendered diagnoses, on Axis I, of
dysthymia and intermittent explosive disorder. PTSD was not
diagnosed.
The veteran's claim of entitlement to service connection for
PTSD is not well grounded, because there is no competent
medical evidence of a diagnosis of PTSD in his case, and the
claim must be denied on that basis. 38 U.S.C.A. § 5107(a);
Epps.
III. Left Knee Disorder.
The service medical records contain notations in April 1968
that the veteran complained of bilateral knee pain on weight
bearing. He had been on leave for a week and had been
drinking heavily. The impression was rheumatism, probably
gouty. A blood uric acid level was ordered, but there is no
indication in the service medical records that the laboratory
test was performed. Subsequent service medical records are
silent as to the knees. In a report of medical history in
September 1969, the veteran stated that he did not have a
trick or locked knee. At an examination for discharge in
September 1969, the veteran's lower extremities were
evaluated as normal.
Private medical treatment records show that the veteran
injured his left knee in April 1985, when he slipped and
fell. At a private hospital, he was seen in the emergency
room and the diagnosis was inferior pole patellar fracture
and retinacular tears of the left knee with partial anterior
cruciate ligament tear. He underwent left knee arthroscopy,
open reduction and internal fixation of the left inferior
patella, and repair of the retinaculum.
The claims file does not contain any evidence of treatment of
the veteran's left knee since the surgery in April 1985,
which is over 15 years ago, and the veteran has not stated
that the knee has required treatment. There is absolutely no
medical evidence that the veteran currently has a left knee
disability. His service connection claim is thus not well
grounded and must be denied on that basis. 38 U.S.C.A.
§ 5107(a); Epps.
The veteran has stated that he has a left knee disorder.
However, as a layperson, he is not qualified to offer an
opinion on a question of medical diagnosis. See Espiritu v.
Derwinski, 2 Vet. App. 492, 494-5 (1992). The veteran's
statements thus do not serve to make his claim well grounded.
The Board is not aware of any circumstances in this matter
which would put VA on notice that relevant evidence may exist
or could be obtained, which, if true, would make the claims
for service connection for PTSD and a left knee disorder
"plausible". See generally McKnight v. Gober, 131 F.3d
1483, 1484-5 (Fed. Cir. 1997).
The Board views its discussion as sufficient to inform the
veteran of the elements necessary to present well grounded
claims for service connection for PTSD and a left knee
disorder, and the reasons the claims have failed at this
time. See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995).
ORDER
A well grounded claim not having been submitted, service
connection for PTSD is denied.
A well grounded claim not having been submitted, service
connection for a left knee disorder is denied.
JAMES A. FROST
Acting Member, Board of Veterans' Appeals